Case 2
An 81-year-old woman was diagnosed with RA at the age of 27 years. She
was treated with methotrexate (6 mg/week) and prednisolone (4 mg/day).
She had been treated with denosumab (60 mg/6 months) and vitamin D for
osteoporosis (the bone mineral density T-score of the left hip was
-2.8). She had previously undergone partial talectomy (only the
protruded region) 8 years prior for recurrent skin infection of the
contact region with floor in her left foot. During this surgery, a bony
protrusion of the talus caused by a calcaneovalgus abnormality was
removed. Callosity was detected in her left foot, and a severe
calcaneovalgus deformity remained (Figure 4 A, B). The patient presented
to our hospital complaining of gait and weight-bearing pain in her left
ankle joint. The radiographic findings in the patient’s left ankle joint
was Larsen Grade IV in both the talocrural and subtalar joints (Figure 5
A, B), and we decided to perform ankle arthrodesis to correct the
deformity and improve the functional outcome.
We used the same surgical approach and grafting procedure (Figure 6 A,
B) for this patient as those described in Case 1. The finned
intramedullary retrograde ankle nail was inserted from the plantar side.
Postoperative care was the same as in Case 1. Macroscopic findings
showed correction of ankle alignment and no skin issues 1 year
postoperatively (Figure 7 A−C).